Analysis of Impella for Treatment of Acute Myocardial Infarction and Cardiogenic Shock: Outcomes of the RECOVER III Post-Approval Study by SCAI Shock Stage

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Conference Proceeding

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Journal of the Society for Cardiovascular Angiography & Intervention


Background: Recently, the Society of Cardiovascular Angiography and Interventions (SCAI) proposed an alphabetical staging system (A-E) to predict prognosis in cardiogenic shock. Herein, we report clinical outcomes of patients enrolled in RECOVER III, highlighting the impact of the SCAI Shock Stage on outcomes. Methods: The RECOVER III study is an observational, prospective, multicenter, single-arm, FDA-audited post-approval study of patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) at 41 sites undergoing percutaneous coronary intervention (PCI) with Impella support initiated before, during, or after PCI. Presence of an Impella device was required for enrollment in RECOVER III, otherwise management of CS was left to the discretion of individual sites. Patients enrolled in RECOVER III were assigned a baseline SCAI shock stage by consensus agreement between blinded observers. Staging was then repeated within 24 hours of Impella support. Kaplan Meier survival curve analyses were conducted to assess survival across SCAI shock stages at both time points. Results: A total of 413 RECOVER III patients were considered eligible and included in the analysis. All patients were at least stage C due to presence of an Impella device. Thirty-day survival amongst patients with Stage C, D and E shock at baseline was 59.7%, 56.5% and 42.9%, respectively (p¼0.003). Survival amongst patients with Stage C, D and E shock at 24 hours was 65.7%, 52.1% and 29.5%, respectively (p<0.001). After multivariate analysis of shock stage, only stage E at 24 hours was a significant negative predictor of survival (OR 4.8 for mortality, p<0.0001). Conclusions: In this “real-world” cohort of patients with AMICS undergoing PCI with Impella support, survival was highly dependent on SCAI shock stage at baseline. Repeat shock stage assessment within 24 hours affords incremental prognostic value




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SCAI Society for Cardiovascular Angiography and Interventions 2023 Scientific Sessions, May 18-20, 2023, Phoenix, AZ

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